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BACKGROUND: We here report on results from a prospective study comprising 380 infertile couples undergoing infertility work-up and various treatments for infertility in our clinic. The aim was to investigate the overall birth rate as a result of different treatments, as well as spontaneous pregnancies.

METHODS: Three hundred and eighty couples were consecutively included between December 2005 and May 2008. All couples underwent a fertility work-up, including hysterosalpingogram, hormonal characterization, clinical examination, screening for infectious diseases and semen analysis. The mean age of the women at the time of inclusion was 33.2 years. The mean duration of infertility prior to inclusion was 1.8 years. And 46.6% (n = 177) of the women had been pregnant prior to their first visit to the clinic and 30.0% (n = 114) had been pregnant earlier in their present relationship.

RESULTS: As of November 2010, 57.3% (n = 218) of the women had given birth to a child when they were lost to follow up by the study. Spontaneous conception was observed in 11.3% (n = 43) of the women, 14.5% (n = 64) conceived after intrauterine insemination (IUI), 4.2% (n = 16) conceived after ovarian hyperstimulation and ovulation induction (OH/OI) and 28.4% (n = 113) after in vitro fertilization. There were 280 pregnancies and 58 spontaneous abortions (22.3%) in the group. Mean anti-mullerian hormone significantly correlated with antral follicle count and age and was significantly higher in the subgroup that became pregnant after IUI.

CONCLUSIONS: Spontaneous pregnancies and IUI + OH/OI contributed significantly to the pregnancies observed in the total population. Predictive factors for pregnancy were anti-mullerian hormone in the group undergoing IUI treatment and in the age group ≥38-duration of infertility. Previous pregnancies, body mass index, estradiol, follicle stimulating hormone or having given birth prior to the infertility period were not predictive of pregnancy for the infertile couples in this study.

Healthcare-associated infections constitute a threat to patient safety and an economic burden on health systems worldwide. The most effective way to prevent healthcare-associated infections is through proper hand hygiene practice, but studies show that compliance is low. In 2009, the World Health Organization released hand hygiene guidelines and tools to address the issue.

Aim

The aim of the study was to measure the compliance to the WHO Guidelines on Hand Hygiene in Health Care among nursing staff in a private hospital in the Philippines using the evaluation framework of the World Health Organization.

Method

The method used to assess compliance was structured direct observations using the World Health Organization’s observation form. Data was collected in 15 days, during full shifts, and analyzed quantitatively based on overall compliance, according to indication, ward, week day/weekend and shift.

Results

A total of 1920 opportunities were recorded, of which 336 were hand rub performances, 168 hand wash and 1416 missed opportunities, giving an overall compliance of 26.25 percent. The ward with the highest compliance rate was the Neonatal Intensive Care Unit (45.40 percent) and the lowest was Nursing Station 1 (22.26 percent).

Conclusion

The overall compliance rate of 26.25 percent is lower compared to most published studies and healthcare workers were more compliant to indications that protect themselves than to indications that protect patients. The results can be useful in improving quality of care and patient safety.

BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.

METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.

RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.

CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.

BACKGROUND: The outcome for many patients with a hip fracture remains poor. The aim of the present study was to investigate whether the timing of surgery in such patients could influence the short-term clinical outcome. METHODS: We included 850 consecutive patients with a hip fracture who were admitted to the hospital during one year in a prospective study. Three cutoff limits for a comparison of early and late operation were defined. The outcome (the ability to return to independent living, risk for the development of pressure ulcers, length of the hospital stay, and mortality rate) for patients who had an operation within twenty-four, thirty-six, and forty-eight hours was compared with the outcome for those who had an operation at a later time. RESULTS: Patients who had the operation more than thirty-six and forty-eight hours after admission were less likely to return to independent living within four months (odds ratio, 0.44 and 0.33, respectively), whereas there was no significant difference with use of the twenty-four-hour cutoff limit. The incidence of pressure ulcers in the groups that had the operation later was increased at all three cutoff limits (a delay of more than twenty-four hours, more than thirty-six hours, and more than forty-eight hours) (odds ratio, 2.19, 3.42, and 4.34, respectively). The length of hospitalization was also increased in the groups that had the later operation (median, fourteen compared with eighteen days, fifteen compared with nineteen days, and fifteen compared with twenty-one days, respectively) (p < 0.001 for all comparisons). The importance of surgical timing remained significant after adjusting for several possible confounders (p < 0.05). CONCLUSIONS: Early compared with late operative treatment of patients with a hip fracture is associated with an improved ability to return to independent living, a reduced risk for the development of pressure ulcers, and a shortened hospital stay.

Background: Pain is one of the most common medical problems that occur in hospitals; in spite of its incidence, there are many patients who suffer with untreated pain. Unrelieved pain can negatively impact a person's quality of life, causing activity life disturbances like psychological distress; anxiety, depression and lack of sleep. Cardiovascular disorder is a significant global health problem, which accounts for the death of a third of people of the world. Chest pain is the most common symptom of heart attacks. However, some patients will present with pain in other areas like pain in arm, shoulder, neck, teeth, jaw and back pain. In literature there is little observational research to investigate actual pain assessment and management practices of critical care nurses in routine clinical practice for patients with myocardial infarction. Aim:The aim of this study was to explore nurses' perceptions regarding pain assessment and pain management for patients with Myocardial Infarction in a coronary care unit.

Methodology: The study was a qualitative design, using semi structured interviews. Ten critical care nurses who work in a coronary care unit were interviewed. The author used a qualitative content analysis approach to analyze the interviews by doing the manual analyzing and having different themes.Result: Three main themes were indentified in this study and each theme had different categories which are presented as the following: Dealing with patients who have myocardial infarction pain is challenging; there are different approaches in pain assessment including subjective and the third theme is Holistic approaches to pain management.

Conclusion: Critical care nurses need more skills and knowledge to practice good pain assessment and effective pain management when they deal with patients who have myocardial infarction pain. In this study patients who do not verbalized their pain lack the proper assessment of pain due to inability to communicate their pain. More research is needed in this area of pain assessment and management especially for patients with myocardial infarction.

INTRODUCTION: The recommended urgent surgical management of ocular motility restriction due to orbital muscle entrapment or impingement associated with orbital wall fracture needs to be elucidated.

AIM: To evaluate the importance of the time from injury to surgery for the outcome in ocular motility and diplopia, the time lapse of ocular motility, diplopia and hypesthesia recovery.

MATERIAL AND METHODS: Patients with entrapment or impingement of orbital contents due to orbital wall fracture were followed up prospectively over 1year regarding ocular motility, diplopia, hypesthesia and cosmetic deformity.

RESULTS: 21 patients (10 entrapments and 11 impingements) were included and treated surgically. The median time from injury to surgery was 36 (8-413)h for the entrapment group and 168 (48-326)h for the impingement group. The median time from study inclusion to surgery was 0 (0-1) days for the entrapment group and 1.0 (0.2-4.8) days for the impingement group. All the patients had ocular motility limitation and diplopia at the inclusion. Ocular motility improved gradually and was normal at final visit. Diplopia resolved gradually in all patients except in two with non-disturbing diplopia, at the final visit. Forced duction test was positive in 90% of the patients in the entrapment group and 70% in impingement group. At final visit, hypesthesia was found in none of the patients in the entrapment group but in 4 patients in the impingement group.

CONCLUSIONS: In this, the first prospective long term follow up of orbital wall fractures with ocular motility restriction, we did not find any significant correlation between the time from injury to surgery and the outcomes in ocular motility and diplopia. An entrapment requires surgery as soon as possible; however, the surgical reduction is at least as important as surgical timing. Surgery should be delayed until it can be performed by an experienced surgeon. Ocular motility restriction causing diplopia due to impingement is not an ophthalmologic emergency and surgery is recommended if the diplopia and ocular motility has not improved over time. Clinical examination of ocular motility and not CT scan findings is crucial to determine whether a limitation of ocular motility exists or not.

Threats and violence towards ambulance staff is getting more common within the society. The frequency of threats and violence towards ambulance staff is high. Ambulance staff are reported to have the highest risk of being exposed to threats and violence at work since they are likely the first to meet the patients in need for emergency care. Work related threats and violence at work affects employers and employees in the shape of comfort, economic and quality of care.

The aim was to highlight the scientific substrate for the ambulance staff experience and how that they are affected by work related threats and violence.

Method used was a literature review where 18 scientific articles were included, where the results were analyzed with an integrated data analysis and reported in categories and subcategories.

In the category ambulance staff´s external impact of threats and violence based on subcategories Worries about self-safety and the importance of the team, Risks at work, and the category Being able to protect patient safety, showed concern for personal safety, the importance of support from employer and colleagues. Result showed that the risk of being exposed to threats and violence increased when patients were affected by drugs or alcohol and work at night. Opportunity and difficulty in protecting patient safety in violent situations arise. In the category ambulance staff´s internal impact of threats and violence based on subcategories Long-term stress and vulnerability as well as Post-traumatic stress disorder PTSD, showed how the staff experienced long-term stress, personality change and in some cases showed higher risk to develop posttraumatic stress syndrome at repeated work-related threats and violence.

The study results show that work-related threats and violence among ambulance staff is a major problem both for employees and employers and in turn affects patients care and their well-being. Ambulance staff are affected both mentally and physically by the vulnerability of threats and violence. Well-being for the ambulance staff is impaired and the workload in nursing is affected.